Medicaid payment for "never events"
State Medicaid directors are advised that as of October 1, 2008, Medicare will no longer pay for the costs of care for certain conditions patients acquire during inpatient care. These conditions are caused by medical errors or other failures by providers and are referred to as "hospital-acquired conditions," or "never events." An unintended result of this policy is that providers may attempt to bill Medicaid for the services furnished to dual eligibles. CMS does not intend for Medicaid funds to pay the costs of never events. States are encouraged to amend their Medicaid plans to avoid this possibility. Three amendments are suggested for the states' selection. States may: (1) adopt their own policies excluding payment for specific, listed never events; (2) exclude from coverage any services for which Medicare has denied payment; or (3) amend their plans to exclude services that meet specified criteria. State Medicaid agencies are encouraged to apply the policy to the entire Medicaid population rather than limiting nonpayment for never events to dual eligibles.
Source: Letter to State Medicaid Directors, No. SMDL-08-004, July 31, 2008.
For more information on this and related topics, consult the CCH® Medicare and Medicaid Guide.
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